Fecal Microbiota Transplantation for the Management of Recurrent Clostridium Difficile Infections: A Systematic Review
Chinanu Ihuoma Nwankwo
College of Medicine, Enugu State University of Science and Technology, Nigeria.
Salman Yousaf *
Services Institute of Medical Sciences (SIMS), Pakistan.
Victor N Oboli
Lincoln Medical and Mental Health Center, NY, USA.
Farzeen Sharaf
Liaquat University of Medical and Health Sciences, Pakistan.
Komal Naz Khalid
Shifa College of Medicine, Pakistan.
Franca Erhiawarie
University of Benin, Nigeria.
Ejiroghene Tejere
Kharkiv National Medical University, Ukraine.
Aqsa Latif
King Edward Medical University, Pakistan.
Ogochukwu Ekpeleamaka Chioma
College of Medicine, Ebonyi State University, Abakaliki, Nigeria.
Chidinma Vivian Ikekpeazu
University of Nigeria, College of Medicine, Nigeria.
Omar Rahim
Kabir Medical College, Pakistan
Imtiaz Nazam
Azra Naheed Medical College, Pakistan.
Toluwani Balogun
Kharkiv National Medical University, Ukraine.
Chidera Precious Chukwuneta
Chukwuemeka Odumegwu Ojukwu University, Nigeria.
Chinonso Ndubuisi
Humboldt Park Health, Illinois, USA.
*Author to whom correspondence should be addressed.
Abstract
Background: Fecal microbiota transplantation (FMT) is a promising therapeutic option for managing Clostridium difficile infections (CDI). CDI is a significant health concern, particularly in antibiotic-resistant cases impairing the quality of life among the patient population. This systematic review aims to pool current clinical trial evidence of FMT (RBX2660) success rates when used for recurrent CDI in the clinical trial setting.
Methods: In accordance with PRISMA Statement 2020 guidelines, the following databases were systematically searched: Embase, PubMed, and Scopus. There were no time or language restrictions. The following keywords were used in all the databases: fecal, microbiota, transplantation, recurrent, Clostridium difficile, infection, and antibiotic-resistant. Only clinical trials, controlled or single-arm, were included in this systematic review.
Results: A total of five clinical trials, of which four were phase II, and one was phase III, were included. Seven hundred ninety-five participants were pooled across all trials. Patients were included in the trials with 1-2 recurrent CDI. In most cases, they had undergone standard antibiotic therapy before enrolling. The treatment success rate in the RBX2660 intervention group was 69.5% (335/482) compared to 49.6% (123/248) in the placebo group. The intervention was safe and effective, with no grade III or higher adverse events reported in treating recurrent CDI.
Conclusion: RBX2660, recently approved as a therapy for recurrent CDI in the United States, is a significant milestone in expanding treatment options. This study reports the potential benefits of FMT and other microbiota-based therapies. While many challenges require addressing, including sample control and patient compliance, FMT is heading toward ongoing acceptance in the broad medical community.
Keywords: Fecal microbiota, transplantation, recurrent, clostridium difficile infections, RBX2660